The Arizona heat takes an extra toll on people with mental illness

Teresa Jimenez Dupee poses for a photo at Hope, Inc., a behavioral health center in Yuma, Arizona. She takes medications for her mental health that affect the way the human body regulates heat. Jimenez Dupee said she has had heatstroke four separate times. (Photo: Lily Altavena/The Republic)

YUMA — When she’s able to keep the voices under control, Teresa Jimenez Dupee hears a spelling bee in her head: a refrain of voices forming long words like superfluous, magnificent and commodities.

But sometimes the voices are more sinister. They tell Jimenez Dupee she’s not pretty, not smart. They say no one will listen to her because she’s crazy.

And they can get worse in the heat, when getting out of bed some days takes an “act of courage.”

Jutting out from the Arizona side of the Colorado River, Yuma often appears high on “hottest cities in the U.S.” rankings. This year’s summer was not a record-setter for the city, but temperatures were hardly mild, with at least five days where the temperature reached 115 degrees or higher, according to the National Weather Service.

In Yuma’s downtown, in a squat brown building, the heat was felt even more sharply.

Sylvia Flores runs the Yuma outpost of Hope Inc., a non-profit behavioral-health center that helps its members manage mental illnesses including schizophrenia, bipolar disorder and depression.

When the temperatures climb, Flores notices the changes in the people she works with. They become more irritated as springtime hastens into summertime. Their eyes get more dilated. They are more blunt. Heat takes an extra toll on people with mental illness.

Medications in the heat

Out of all the people who died of heat-associated causes in Maricopa County in 2016, around 15 percent had a history of mental illness, according to an Arizona Republic analysis of autopsy reports.

A little more than 4 percent of those who died had a medical history of schizophrenia. Nationally, 1.1 percent of the U.S. adult population has schizophrenia, according to the National Institute of Mental Health.

Some medications, including certain types of antidepressants and antipsychotics, block the body’s ability to regulate its temperature, said Dr. David Eisenman, a professor of medicine at the University of California, Los Angeles. This puts behavioral-health patients at a higher risk for heatstroke and other heat-related illnesses.

Jimenez Dupee said she’s had heatstroke four separate times. She is prescribed the antidepressant desvenlafaxine and the antipsychotic haloperidol, both medications Eisenmann said would affect the way a body thermoregulates.

Last year, she passed out after stepping out of her truck, which does not have air-conditioning. She said the incident warranted a trip to Yuma Regional Medical Center.

“It’s very stifling when you get in the car,” she said. “It’s like an anxiety attack. You suffer from those a lot more in the summer than you do in the winter.”

A seasonal roadblock

Rachel Milligan poses at Hope,Inc., a behavioral-health center in Yuma. Milligan said she hears voices and the heat wears on her mental health.(Photo: Lily Altavena/The Republic)

Flores has lived in Yuma her whole life. She spent summers traveling with her parents from farming job to farming job, working in packing houses where she would be assigned tasks such as placing stickers on melons.

“Growing up in Yuma, it's hot. But not as hot as it is now. It's getting hotter.”

Sylvia Flores, Hope Inc.

The heat, to her, is manageable for people who have known it their whole lives. Flores remembers running barefoot to the neighborhood pool in the heat of the day because her parents couldn’t afford sandals and they didn’t want to wear tennis shoes. She would run as fast as she could to avoid the burn of the scalding pavement.

Still, there’s a difference between her childhood and the present day.

“Growing up in Yuma, it’s hot,” she said. “But not as hot as it is now. It’s getting hotter.”

At Hope Inc., Flores starts warning her members about heat early in the season, around April. She wants to make sure they are drinking plenty of water instead of guzzling soda or coffee.

Larissa Flores, Sylvia’s daughter and an outreach specialist at the center, notices that heat becomes a seasonal roadblock for members, who may struggle to take care of themselves.

“They don’t like to go on their walks,” she said. “They don’t keep up with their medications. So we see a lot of them struggling and being irritable and not themselves.”

Pale, with fair skin, Rachel Milligan spends much of her days inside during the summer. She has bipolar disorder and hears voices. The heat wears on Milligan during her daily walk from her apartment to the Fry’s grocery store a few blocks away. Some days, she will put her groceries away and then just sit with the air-conditioning blasting. She sits until her body’s cooled down.

“Summer, it takes my breath away,” she said.

Milligan doesn’t have a car and tries to take walks as often as she can, to get her exercise in. But, “it’s just too hot. It’s horrible.”

'Hard to function' when it's hot

Sylvia Flores, pictured in her office, is the site director the Yuma outpost of Hope Inc., a behavioral =-health center.(Photo: Lily Altavena/The Republic)

Jimenez Dupee tries to walk, too. In the summer, the former Dillard’s makeup artist rises by 5:30 a.m. She showers and then goes for a walk with her dog Kush by 6:30 a.m., when temperatures are in the high 80s.

Her neighborhood in Yuma is peaceful at the early hour. For the rest of the day, she mostly retreats to the inside of her house or other air-conditioned places. Even Kush doesn’t like venturing outside in the heat of the afternoon. Jimenez Dupee will press her own foot to the cement outside her door to see if it’s too hot for the dog’s paws.

Larissa Flores is out in the heat every day. Part of her job includes engaging with the homeless community living by the Colorado River, which runs on the outskirts of the main downtown Yuma area. Flores tries to identify people in particularly vulnerable mental-health situations, to try to find them housing.

The river is a popular spot for the homeless population in the city, a convenient gateway from Arizona to California. Flores' job is harder on hot days, when she says it seems like everyone is hiding in shady spots.

Even the younger Flores can feel the heat chipping away at her calm demeanor on a long day.

“It’s just hard to function whenever you’re really hot and irritable and uncomfortable,” she said.